摘要
目的了解超早产儿校正年龄24月龄内营养不足及适宜追赶的状况。方法回顾性队列研究。选择2017年1月至2022年12月南方医科大学妇女儿童医学中心深圳市妇幼保健院出生并跟踪随访至校正年龄24月龄的422例超早产儿, 按照出生胎龄(<25、25~26、27周)、出生体重(<500、500~749、750~999、≥1 000 g)、出生胎龄的体重(大于胎龄、适于胎龄、小于胎龄)及性别分组。校正年龄0~24月龄, 每3个月为1个随访时间段收集体重数据。采用Z评分法分析数据, 校正胎龄40周前采用Fenton早产儿生长曲线图2013版(Fenton 2013), 校正胎龄40周及以后采用世界卫生组织儿童生长曲线(2006年版)拟合Z值, 观察并比较超早产儿校正年龄0~24月龄体重Z值变化, 判断是否发生中重度营养不良及生长减缓, 以此评价营养不足状态, 分析生长速率及适宜追赶情况。采用改良偏度系数-中位数-变异系数法结合Z值拟合模型对超早产儿体重百分位数的分布特征进行拟合与分析;采用χ2检验比较组间差异。结果 422例超早产儿中男238例、女184例, 出生胎龄26.3(25.4, 27.2)周, 出生体重(880±177)g;大于胎龄 36例(8.5%), 小于胎龄16例(3.8%)。校正年龄0~24月龄89例(21.1%)超早产儿出现中重度营养不良。不同出生体重、出生胎龄组分别比较, 中重度营养不良发生率差异均有统计学意义(χ^(2)=42.94、9.17, 均P<0.05), <500 g组和<25周组组内分别最高, ≥1 000 g和27周组组内分别最低。生长减缓22例(5.2%), 不同出生体重和出生胎龄组在校正年龄各随访时间段生长减缓发生率差异均有统计学意义(χ^(2)=21.61、4.30, 均P<0.05)。校正年龄0~3及3~6月龄快速生长比例较高, 分别为96例(27.4%)及98例(26.6%)。校正年龄24月龄内总体适宜追赶完成341例(80.8%), 不同出生体重、出生胎龄组适宜追赶完成率差异均有统计学意义(χ^(2)=23.65、7.08, 均P<0.05), <500 g组和<25周组组内分别最高, ≥1 000 g和27周组组内分别最低。结论超早产儿出生体重及出生胎龄越低, 校正年龄24月龄内中重度营养不良的发生率越高, 适宜追赶完成率越低。校正年龄0~6月龄为超早产儿的快速追赶期。
ObjectiveTo assess the status of undernutrition and appropriate catch-up growth in extremely preterm infants within 24 months of corrected age(CA).MethodsA retrospective cohort study was conducted.A total of 422 extremely preterm infants born at Shenzhen Maternity and Child Healthcare Hospital,Women and Children's Medical Center,Southern Medical University from January 2017 to December 2022 and followed up until 24 months of CA were enrolled.The extremely preterm infants were grouped by gestational age at birth(<25,25-26,27 weeks),birth weight(<500,500-749,750-999,≥1000 g),weight for gestational age(large for gestational age(LGA),appropriate for gestational age(AGA),small for gestational age(SGA))and sex.Weight data within 24 months of CA were collected every 3 months.Nutritional insufficiency,growth rate,and achievement of adequate catch-up growth were analyzed during the period from 0 to 24 months of CA.Z-score method was used to analyze data.Fenton 2013 preterm growth charts(Fenton 2013)were used before 40 weeks of corrected gestational age,and World Health Organization child growth standards(2006)fitted Z-scores were applied from 40 weeks of CA.Changes in weight Z-scores of extremely preterm infants from 0 to 24 months of CA were observed and compared,the occurrence of moderate to severe malnutrition and growth retardation was determined,nutritional insufficiency was assessed,and growth rate as well as the achievement of appropriate catch-up growth were analyzed.The Lambda-mu-sigma method combined with the Z-score fitting model was used to fit and analyze the distribution characteristics of weight percentiles in extremely preterm infants.The Chi-square test was used to compare differences among groups.ResultsA total of 422 extremely preterm infants were included,with a gestational age at birth of 26.3(25.4,27.2)weeks and a birth weight of(880±177)g.Among them,238 were males and 184 were females;36 cases(8.5%)were LGA,and 16 cases(3.8%)were SGA.During follow-up within 24 month of CA,89 cases(21.1%)developed moderate to severe malnutrition.When compared separately among different birth weight and gestational age at birth groups,there had both statistically differences in the incidence of moderate to severe malnutrition(χ^(2)=42.94 and 9.17,both P<0.05).The incidence was the highest in the birth weight<500 g group and the<25 weeks gestational age at birth group,while it was the lowest in the birth weight≥1000 g group and the 27 weeks gestational age at birth group in their respective groups.Growth retardation occurred in 5.2%(22/422).However,there had statistically differences in the incidence of growth retardation among different birth weight and gestational age at birth groups,in each grouped time interval(χ^(2)=21.61 and 4.30,both P<0.05).The proportions of rapid growth were relatively high in the 0-3 months and 3-6 months of CA groups,which were 96 cases(27.4%)and 98 cases(26.6%),respectively.Overall,appropriate catch-up growth was achieved in 341 cases(80.8%)from 0 to 24 months of CA.There had statistically differences in the completion rate of appropriate catch-up growth among different birth weight and gestational age at birth groups(χ^(2)=23.65 and 7.08,both P<0.05).The completion rate was the highest in the birth weight<500 g group and the<25 weeks of gestational age at birth group,while it was the lowest in the birth weight≥1000 g group and the 27 weeks of gestational age at birth group.ConclusionsThe lower the birth weight and gestational age of extremely preterm infants,the higher the incidence of moderate to severe malnutrition and the lower the achievement rate of adequate catch-up growth within 24 months of CA.The period of 0-6 months of CA is the critical window for catch-up in extremely preterm infants.
作者
屈小莉
彭春锦
赵依雪
杨玉兰
罗娜
王萍
Qu Xiaoli;Peng Chunjin;Zhao Yixue;Yang Yulan;Luo Na;Wang Ping(Department of Child Psychology and Rehabilitation,Shenzhen Maternity and Child Healthcare Hospital,Women and Children′s Medical Center,Southern Medical University,Shenzhen 518017,China;Division of Neonatology,Guangzhou Women and Children′s Medical Center,Guangzhou Medical University,Guangzhou 510623,China)
出处
《中华儿科杂志》
北大核心
2026年第1期68-76,共9页
Chinese Journal of Pediatrics
基金
深圳市医学重点学科(SZXK071)
南方医科大学妇女儿童医学中心深圳市妇幼保健院院内科研基金(FYB2022009)。
关键词
婴儿
早产
营养不良
生长减缓
追赶生长
队列研究
Infants,premature
Malnutrition
Falteringgrowth
Catch-up growth
Cohort studies
